Complementary food supplements (CFS) are fortified food-based home fortification products that contain both macronutrient and micronutrient contents. CFS are added to other foods (as “point of use” fortificants) or eaten alone to improve both macronutrient and micronutrient intake. Complementary food supplements can increase the fat content of the normal diet and provide essential fatty acids, milk, micronutrients, macrominerals and high-quality protein.
Small-quantity lipid-based nutrient supplements
Lipid-based nutrient supplements, a type of CFS, are considered “lipid-based” because most of the energy provided by these paste-type products is from lipids (fats). They provide a range of vitamins and minerals, and unlike MNP and other multiple micronutrient supplements, LNS also provide energy, protein, macro-minerals and essential fatty acids, in addition to micronutrients. LNS recipes can include a variety of ingredients, but typically contain vegetable oil, peanut/groundnut paste, soy protein, milk powder and sugar. They are safe to store without refrigeration.
Small-quantity LNS products are intended to be added to foods. A very small amount (~20g per day) may be used for home fortification for infants and young children starting at 6 months of age. This type of LNS provides a relatively low dose of energy (calories) and a full range of vitamins, minerals, and essential fatty acids, many of which may be deficient in infant diets. These small quantities of LNS are designed to enhance the nutrient content of local complementary foods, not to replace them. Small-quantity LNS provide less than 120 calories/day.
Small-quantity LNS can be stored for up to 18 months, even in hot conditions (although it is best to avoid long-term exposure above 40° C), and are low-cost (although more expensive than MNP at present), depending on volume produced and site of production. Small quantity LNS cost information can be found at https://supply.unicef.org/.
While inconclusive, research on small quantity LNS (≤120 kcal/d, ≤20 g/d) in older infants and young children is on-going and suggests benefits related to linear growth (height), infant development and micronutrient deficiencies (http://www.ilins.org). Although some programs are already moving ahead to start using small quantity LNS, until there is further evidence, HF-TAG cannot yet make programmatic recommendations for this product.
For more information on SQ-LNS, read here: http://ilins.org/resources/faq
NB: There are several other LNS products in addition to small quantity LNS, such as the large quantity ready-to-use therapeutic foods (RUTF, 92 g/sachet, for example Plumpy'NutTM and eeZeeRUTFTM) and ready-to-use supplementary foods (RUSF, for example Plumpy'SupTM and AchaMumTM) that are now widely used in treating severe- and moderate-acute malnutrition, respectively. Medium quantity LNS (45 g/d, for example Plumpy'DozTM and WawaMumTM) is typically used to prevent wasting during periods of severe food insecurity, such as lean seasons. Although well known and provided by agencies such as WFP, UNICEF and MSF, these large and medium quantity LNS products are not considered home fortification products because they provide a larger proportion of daily energy needs and are therefore providing foods not “fortifying”them.
Multi-nutrient powders containing vitamins and minerals plus food ingredients such as full fat soy flour and soy protein, milk powder, and other ingredients (also known as “Ying Yang Bao” in Chinese)
Ying Yang Bao (YYB), for example, is another type of CFS that is a micronutrient powder mixed with full-fat soybean powder. YYB was developed by the Chinese Center for Disease Control and Prevention. The original formulation includes 10 g of full-fat soybean flour, iron, zinc, calcium, and vitamins B2 and D.
In a large-scale trial, YYB was found to improve growth and development and decrease anemia in children aged 4-12 months in Gansu, China. Because of the success of the product and the need for it during the Sichuan Province earthquake emergency in 2008, the Chinese government enacted a standard for complementary food supplements, which covers YYB. Since then, there have been six YYB projects using modified versions of the original formulation conducted in more than 12 counties across 8 western and central provinces (including Shanxi, Shaanxi, Sichuan, Xinjiang, Guizhou, Guanxi, Qinghai, and Yunnan Provinces). The new formulation contains an additional four micronutrients (vitamins A, B1, B12 and folic acid).
After UNICEF’s piloting in 8 counties of Wenchuan earthquake affected areas and other related intervention projects, such as the MDG nutrition project, Qinghai Provincial government provided funds to procure soybean powder-based YYB for children aged 6-24 months in 15 poverty counties. The Central government allocated funds to children in 100 national poverty counties for soybean powder based YYB intervention. YYB is stable for 12 months and is preferably stored under cool (not exceeding 40° C) and dry conditions. Although the cost for YYB varies and there is no standard procurement system for it, the cost per serving is likely lower than small quantity LNS and higher than MNP.